Sunday, November 25, 2007
Life, Health + Fitness

Is surgery an option for treatment of tremor?

Should I consider deep brain stimulation?

Q I’ve been able to control my essential tremor with medication for years. But despite maximum doses, I am getting less benefit and experiencing side effects. Even drinking a cup of coffee is difficult. Should I consider deep brain stimulation?

A Deep brain stimulation (DBS) is a form of brain surgery. An electrode is implanted in the area of the brain called the thalamus and a thin, insulated wire connects it to a pacemaker-like stimulator that is placed under the skin below the collarbone. The stimulator is then programmed to send continuous electrical pulses to the brain. It suppresses tremor by blocking the brain signals that cause the uncontrollable shaking. The device can be turned on and off by the patient swiping a special magnet over the stimulator. For example, patients typically turn off the device at night because the tremor stops during sleep.

Deep brain stimulation can be done on one or both sides of the brain, depending on the patient’s symptoms. The patient is initially awake while an electrode is placed to determine how well the tremor is being suppressed and to report side effects, which are generally mild and reversible. The most common side effects are a temporary tingling in the limbs and slurred speech.

While not a cure, DBS treats the symptoms of an underlying physical disorder in the brain, and does it very well. Patients report inspiring tales of returning to careers in teaching and medicine, resuming travel, socializing and eating out in restaurants for the first time in years. In addition, the need for anti-tremor medications is often reduced or eliminated.

Before considering DBS, discuss your condition with your physician to be sure all medical therapies have been fully explored. If your condition is not responsive to available therapies to control tremor, then you may be a candidate for evaluation for this surgery at a medical center experienced in the procedure.

Developed in Europe, deep brain stimulation was first approved by the Food and Drug Administration in 1997 to treat essential tremor (a disorder that is not usually linked to serious disease and that causes the limbs or head and neck to shake when muscles are in action but not when they are at rest). The surgical procedure has since been approved to treat select cases of Parkinson’s disease and dystonia, a movement disorder characterized by involuntary, sustained muscle contractions.

The basic surgical procedure for these other diseases is similar. However, the target areas for electrode placement in the brain differ.

Research at Mayo and other institutions is helping to cautiously extend the benefits of deep brain stimulation to other disorders in some patients. For example, surgeons have used it on a very limited basis for intractable chronic cluster headaches with good results. Further research is under way for applying it to certain cases of depression and obsessive-compulsive disorder.

The procedure is worth discussing with your physician. When performed by skilled and experienced care teams, DBS can be a safe and effective means of improving some patients’ quality of life. —Kendall Lee, M.D., Ph.D., Neurologic Surgery, Mayo Clinic, Rochester, Minn. SP